Concomitant cisplatin and extended field radiation therapy in patients with cervical and endometrial cancer

The purpose of this study is to evaluate the toxicity and safety of concomitant cisplatin (CDDP) and extended field radiation therapy (EFRT) in patients with cervical cancer (CxCA) and endometrial cancer (EnCA). Twenty-five patients were analyzed retrospectively for treatment-related morbidity from 1989 to 1998. Fourteen patients had CxCA and 11 patients had EnCA. Eighteen patients (72%) had surgery prior to radiotherapy and chemotherapy. EFRT was delivered by a four-field technique to the pelvis and para-aortic regions. CDDP at 100 mg/m2 was given over 5 days during 1st and 4th week of EFRT. EFRT dose for EnCA and CxCA was 45 Gy. Toxicity was analyzed using the RTOG toxicity criteria.Twenty-four (96%) of the 25 patients completed the prescribed therapy. Of the 14 patients with CxCA, three (21%) had no toxicity, three (21%) had grade 1–2, and eight (58%) had grade 3–4 hematologic toxicities. Overall six (24%) had grade 3–4 acute gastrointestinal toxicities, three (21%) of these patients were treated for cervix cancer and three (27%) patients were treated for endometrial cancer. The worst (Grade 3–4) toxicities in 15 patients occurred after the 4th week of radiotherapy. In six of 25 (24%) patients radiation treatments had to be delayed due to toxicities. The median delay of treatment was 10.5 days (range 7–31 days). Of the six patients who had grade 3–4 acute gastrointestinal toxicities, four (66%) had undergone exploratory laparotomy and lymph node sampling prior to start of chemoradiation.We conclude that concomitant EFRT and CDDP appears to be safe with moderate but manageable toxicity. Toxicity is most severe after the 4th week of treatment. Morbidity may be worse in patients with prior laparotomy.

Download Full-text

Concomitant cisplatin and extended field radiation therapy in patients with cervical and endometrial cancer

International Journal of Gynecological Cancer ◽

10.1046/j.1525-1438.2002.01172.x ◽

2002 ◽

Vol 12 (5) ◽

pp. 459-464 ◽

Cited By ~ 24

Author(s):

B. M. Sood ◽

P. F. Timmins ◽

G. R. Gorla ◽

M. Garg ◽

P. S. Anderson ◽

...

Keyword(s):

Radiation Therapy ◽

Endometrial Cancer ◽

Field Radiation ◽

Extended Field

Download Full-text

Dosimetric predictors of nephrotoxicity in patients receiving extended-field radiation therapy for gynecologic cancer

Radiation Oncology ◽

10.1186/s13014-021-01755-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Hiroaki Kunogi ◽

Nanae Yamaguchi ◽

Yasuhisa Terao ◽

Keisuke Sasai

Keyword(s):

Renal Function ◽

Radiation Therapy ◽

Endometrial Cancer ◽

Cancer Patients ◽

Correlation Coefficients ◽

Dose Volume ◽

Dose Constraint ◽

Field Radiation ◽

Extended Field ◽

Pre Treatment

Abstract Purpose We sought dosimetric predictors of a decreasing estimated glomerular filtration rate (eGFR) in gynecological oncology patients receiving extended-field radiation therapy (EFRT). Materials and methods Between July 2012 and April 2020, 98 consecutive cervical or endometrial cancer patients underwent EFRT or whole-pelvis radiation therapy (WPRT) with concurrent cisplatin chemotherapy in our institution. To explore the effect of concurrent cisplatin chemotherapy on renal function, the renal function of the WPRT patients was examined. Of the 98 patients, 34 cervical or endometrial cancer patients underwent EFRT including extended-field intensity-modulated radiation therapy (EF-IMRT) and 64 cervical cancer patients underwent WPRT with cisplatin. Of the 34 EFRT patients, 32 underwent concurrent cisplatin chemotherapy. Excluding patients exhibiting recurrences within 6 months, 31 EFRT patients were analyzed in terms of the dose-volume kidney histograms (the percentages of kidney volumes receiving 12, 16, 20, and 24 Gy) and the post- to pre-treatment eGFR ratios. We calculated Pearson correlation coefficients between the renal dose volume and the percentage eGFR reductions of the 31 EFRT patients, and those treated via EF-IMRT. Renal dose constraint significance was evaluated using the Mann–Whitney U test. Results The eGFR value after WPRT with cisplatin remained largely unchanged for 12 months, unlike that after EFRT. In EFRT patients, a strong correlation was evident between the KV20Gy dose and the post- to pre-treatment eGFR ratio (correlation coefficients − 0.80 for all patients and − 0.74 for EF-IMRT patients). In EF-IMRT patients, the kidney volume receiving 20 Gy tended to correlate negatively with the eGFR reduction. The Mann–Whitney U test showed that patients with KV20Gy values < 10% retained significantly better renal function than did patients with KV20Gy values > 10% (P = 0.002). Conclusions Imposition of a severe kidney dose constraint during EF-IMRT may reduce nephrotic toxicity. Future prospective investigations of kidney-sparing EF-IMRT are required.

Download Full-text

Retrospective analysis of acute and late gastrointestinal and hematological toxicities with extended field radiation in gynaecological malignancies: A single institution data

10.1055/s-0039-1685352 ◽

2016 ◽

Author(s):

Chaitanya Medichelme ◽

Shagun Juneja ◽

Anirudh Punnakal ◽

Charu Garg ◽

Indu Bansal ◽

...

Keyword(s):

Volumetric Modulated Arc Therapy ◽

Late Toxicity ◽

Concurrent Chemotherapy ◽

Planning System ◽

Hematological Toxicity ◽

Ct Simulation ◽

Field Radiation ◽

Extended Field ◽

Gynaecological Malignancies ◽

Grade 3

Purpose: The aim of this study is to report a preliminary analysis of our clinical experience with extended field pelvic (conformal) radiation, with or without concurrent chemotherapy, in gynaecological malignancies. Materials and Methods: 27 women with gynaecological malignancies (17 with Carcinoma Cervix and 10 with Carcinoma Endometrium) were treated between November 2009 and October 2015 with Extended Field abdomino-pelvic radiation. All patients were treated with conformal radiation (Intensity Modulated Radiotherpy or Volumetric Modulated Arc Therapy). All patients underwent CT Simulation followed by target and OAR delineation as per RTOG guidelines. Dose prescriped was 45-50 Gy in 1.8 Gy per fraction and boost to gross node upto 54-56 Gy. Planning was done on Eclipse Planning system, and treatment was delivered on 6 MV linac. Concurrent chemotherapy was given when indicated. All toxicities were scored according to Common Terminology Criteria for Adverse Events (CTCAE v 4.03). Dosimetric parameters were correlated with toxicities. Results: Median follow up was 9.5 months (Range 0-52 months). 14 (51.8%) patients developed Grade 1 and 2 acute hematological toxicity and 1 (0.04%) developed Grade 3 toxicity. 10 (37%) patients developed Grade 1 and 2 acute gastrointestinal toxicity and 1 (0.04%) developed grade 4 toxicity. 3 (11.12%) patients had late toxicity in the form of prolonged leucopenia, SAIO, and Irritable Bowel Syndrome. 1 patient did not complete her treatment due to persistent leucopenia (Grade 3). Conclusion: Extended field Radiation in Gynaecological malignancies is a reasonably well tolerated procedure when treated with IMRT or VMAT, with acceptable toxicity profile.

Download Full-text

Feasibility of concurrent cisplatin and extended field radiation therapy (EFRT) using intensity-modulated radiotherapy (IMRT) for carcinoma of the cervix

Gynecologic Oncology ◽

10.1016/j.ygyno.2005.12.044 ◽

2006 ◽

Vol 102 (2) ◽

pp. 182-188 ◽

Cited By ~ 46

Author(s):

Kristina Gerszten ◽

Kelly Colonello ◽

Dwight E. Heron ◽

Ron J. Lalonde ◽

Issa D. Fitian ◽

...

Keyword(s):

Radiation Therapy ◽

Intensity Modulated Radiotherapy ◽

Intensity Modulated ◽

Field Radiation ◽

Extended Field

Download Full-text

Extended-field radiation therapy for carcinoma of the cervix

Cancer ◽

10.1002/1097-0142(19900715)66:2<251::aid-cncr2820660210>3.0.co;2-e ◽

1990 ◽

Vol 66 (2) ◽

pp. 251-258 ◽

Cited By ~ 48

Author(s):

Edward Podczaski ◽

John A. Stryker ◽

Paul Kaminski ◽

Boniface Ndubisi ◽

James Larson ◽

...

Keyword(s):

Radiation Therapy ◽

Field Radiation ◽

Extended Field

Download Full-text

Extended-field radiation therapy in early-stage cervical carcinoma: Survival and complications

Gynecologic Oncology ◽

10.1016/0090-8258(91)90008-s ◽

1991 ◽

Vol 43 (1) ◽

pp. 51-54 ◽

Cited By ~ 36

Author(s):

Mary J. Cunningham ◽

Charles J. Dunton ◽

Benjamin Corn ◽

Joel Noumoff ◽

Mark A. Morgan ◽

...

Keyword(s):

Radiation Therapy ◽

Cervical Carcinoma ◽

Early Stage ◽

Field Radiation ◽

Extended Field

Download Full-text

Three cycles of adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) or epirubicin, bleomycin, vinblastine, and methotrexate (EBVM) plus extended field radiation therapy in early and intermediate Hodgkin disease: 10-year results of a randomized trial

Blood ◽

10.1182/blood-2003-05-1611 ◽

2004 ◽

Vol 103 (1) ◽

pp. 58-66 ◽

Cited By ~ 20

Author(s):

C. l. Maignan

Keyword(s):

Radiation Therapy ◽

Randomized Trial ◽

Hodgkin Disease ◽

Field Radiation ◽

Extended Field

Download Full-text

Outcome of High-Risk Stage IC, Grade 3, Compared With Stage I Endometrial Carcinoma Patients: The Postoperative Radiation Therapy in Endometrial Carcinoma Trial

Journal of Clinical Oncology ◽

10.1200/jco.2004.08.159 ◽

2004 ◽

Vol 22 (7) ◽

pp. 1234-1241 ◽

Cited By ~ 202

Author(s):

Carien L. Creutzberg ◽

Wim L.J. van Putten ◽

Carla C. Wárlám-Rodenhuis ◽

Alfons C.M. van den Bergh ◽

Karin A.J. De Winter ◽

...

Keyword(s):

Radiation Therapy ◽

Endometrial Cancer ◽

High Risk ◽

Endometrial Carcinoma ◽

Postoperative Radiotherapy ◽

Risk Category ◽

Postoperative Radiation ◽

Postoperative Radiation Therapy ◽

Stage Ib ◽

Grade 3

Purpose Stage IC, grade 3 endometrial cancer is regarded as a high-risk category. Stage IC, grade 3 patients were not eligible for the randomized Postoperative Radiation Therapy in Endometrial Carcinoma (PORTEC) trial, but were registered and received postoperative radiotherapy. Patients and Methods The PORTEC trial included 715 patients with stage IC, grade 1 or 2, and stage IB, grade 2 or 3 endometrial cancer. Patients were randomly assigned after surgery to receive pelvic radiotherapy (RT) or no further treatment. A total of 104 patients with stage IC, grade 3 endometrial cancer were registered, of whom 99 could be evaluated. Patterns of relapse and survival were compared with PORTEC patients receiving RT. Median follow-up was 83 months. Results The actuarial 5-year rates of locoregional relapse were 1% to 3% for PORTEC patients who received RT, compared with 14% for stage IC, grade 3 patients. Five-year distant metastases rates were 3% to 8% for grade 1 and 2 tumors; 20% for stage IB, grade 3 tumors; and 31% for stage IC, grade 3 tumors. Overall survival rates were 83% to 85% for grades 1 and 2; 74% for stage IB, grade 3; and 58% for stage IC, grade 3 patients (P < .001). In multivariate analysis grade 3 was the most important adverse prognostic factor for relapse and death as a result of endometrial cancer (hazard ratios, 5.4 and 5.5; P < .0001). Conclusion Patients with stage IC, grade 3 endometrial carcinoma are at high risk of early distant spread and endometrial carcinoma-related death. Novel strategies for adjuvant therapy should be explored to improve survival for this patient group.

Download Full-text